Suzanne V Arnold1, Joshua M Stolker2, Kasia J Lipska2, Philip G Jones2, John A Spertus2, Darren K McGuire2, Silvio E Inzucchi2, Abhinav Goyal2, Thomas M Maddox2, Marcus Lind2, Divya Gumber2, Supriya Shore2, Mikhail Kosiborod2. 1. From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., P.G.J., J.A.S., M.K.); University of Missouri-Kansas City (S.V.A., J.A.S., M.K.); Saint Louis University, MO (J.M.S.); Yale University School of Medicine, New Haven, CT (K.J.L., S.E.I.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Emory School of Medicine, Atlanta, GA (A.G.); VA Eastern Colorado Health Care System, Denver (T.M.M.); University of Gothenburg, Gothenburg, Sweden (M.L.); and Cleveland Clinic Foundation, OH (D.G.). suz.v.arnold@gmail.com. 2. From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., P.G.J., J.A.S., M.K.); University of Missouri-Kansas City (S.V.A., J.A.S., M.K.); Saint Louis University, MO (J.M.S.); Yale University School of Medicine, New Haven, CT (K.J.L., S.E.I.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Emory School of Medicine, Atlanta, GA (A.G.); VA Eastern Colorado Health Care System, Denver (T.M.M.); University of Gothenburg, Gothenburg, Sweden (M.L.); and Cleveland Clinic Foundation, OH (D.G.).
Abstract
BACKGROUND: Diabetes mellitus (DM) is common in patients hospitalized with an acute myocardial infarction (AMI), representing in some cases the first opportunity to recognize and treat DM. We report the incidence of new DM and its recognition among patients with AMI. METHODS AND RESULTS: Patients in a 24-site US AMI registry (2005-08) had glycosylated hemoglobin assessed at a core laboratory, with results blinded to clinicians and local clinical measurements left to the discretion of the treating providers. Among 2854 AMI patients without known DM on admission, 287 patients (10%) met criteria for previously unknown DM, defined by a core laboratory glycosylated hemoglobin of ≥6.5%. Among these, 186 (65%) were unrecognized by treating clinicians, receiving neither DM education, glucose-lowering medications at discharge, nor documentation of DM in the chart (median glycosylated hemoglobin of unrecognized patients, 6.7%; range, 6.5-12.3%). Six months after discharge, only 5% of those not recognized as having DM during hospitalization had been initiated on glucose-lowering medications versus 66% of those recognized (P<0.001). CONCLUSIONS: Underlying DM that has not been previously diagnosed is common among AMI patients, affecting 1 in 10 patients, yet is recognized by the care team only one third of the time. Given its frequency and therapeutic implications, including but extending beyond the initiation of glucose-lowering treatment, consideration should be given to screening all AMI patients for DM during hospitalization. Inexpensive, ubiquitous, and endorsed as an acceptable screen for DM, glycosylated hemoglobin testing should be considered for this purpose.
BACKGROUND:Diabetes mellitus (DM) is common in patients hospitalized with an acute myocardial infarction (AMI), representing in some cases the first opportunity to recognize and treat DM. We report the incidence of new DM and its recognition among patients with AMI. METHODS AND RESULTS:Patients in a 24-site US AMI registry (2005-08) had glycosylated hemoglobin assessed at a core laboratory, with results blinded to clinicians and local clinical measurements left to the discretion of the treating providers. Among 2854 AMI patients without known DM on admission, 287 patients (10%) met criteria for previously unknown DM, defined by a core laboratory glycosylated hemoglobin of ≥6.5%. Among these, 186 (65%) were unrecognized by treating clinicians, receiving neither DM education, glucose-lowering medications at discharge, nor documentation of DM in the chart (median glycosylated hemoglobin of unrecognized patients, 6.7%; range, 6.5-12.3%). Six months after discharge, only 5% of those not recognized as having DM during hospitalization had been initiated on glucose-lowering medications versus 66% of those recognized (P<0.001). CONCLUSIONS: Underlying DM that has not been previously diagnosed is common among AMI patients, affecting 1 in 10 patients, yet is recognized by the care team only one third of the time. Given its frequency and therapeutic implications, including but extending beyond the initiation of glucose-lowering treatment, consideration should be given to screening all AMI patients for DM during hospitalization. Inexpensive, ubiquitous, and endorsed as an acceptable screen for DM, glycosylated hemoglobin testing should be considered for this purpose.
Authors: Lars Rydén; Peter J Grant; Stefan D Anker; Christian Berne; Francesco Cosentino; Nicolas Danchin; Christi Deaton; Javier Escaned; Hans-Peter Hammes; Heikki Huikuri; Michel Marre; Nikolaus Marx; Linda Mellbin; Jan Ostergren; Carlo Patrono; Petar Seferovic; Miguel Sousa Uva; Marja-Riita Taskinen; Michal Tendera; Jaakko Tuomilehto; Paul Valensi; Jose Luis Zamorano; Jose Luis Zamorano; Stephan Achenbach; Helmut Baumgartner; Jeroen J Bax; Héctor Bueno; Veronica Dean; Christi Deaton; Cetin Erol; Robert Fagard; Roberto Ferrari; David Hasdai; Arno W Hoes; Paulus Kirchhof; Juhani Knuuti; Philippe Kolh; Patrizio Lancellotti; Ales Linhart; Petros Nihoyannopoulos; Massimo F Piepoli; Piotr Ponikowski; Per Anton Sirnes; Juan Luis Tamargo; Michal Tendera; Adam Torbicki; William Wijns; Stephan Windecker; Guy De Backer; Per Anton Sirnes; Eduardo Alegria Ezquerra; Angelo Avogaro; Lina Badimon; Elena Baranova; Helmut Baumgartner; John Betteridge; Antonio Ceriello; Robert Fagard; Christian Funck-Brentano; Dietrich C Gulba; David Hasdai; Arno W Hoes; John K Kjekshus; Juhani Knuuti; Philippe Kolh; Eli Lev; Christian Mueller; Ludwig Neyses; Peter M Nilsson; Joep Perk; Piotr Ponikowski; Zeljko Reiner; Naveed Sattar; Volker Schächinger; André Scheen; Henrik Schirmer; Anna Strömberg; Svetlana Sudzhaeva; Juan Luis Tamargo; Margus Viigimaa; Charalambos Vlachopoulos; Robert G Xuereb Journal: Eur Heart J Date: 2013-08-30 Impact factor: 29.983
Authors: Suzanne V Arnold; Paul S Chan; Philip G Jones; Carole Decker; Donna M Buchanan; Harlan M Krumholz; P Michael Ho; John A Spertus Journal: Circ Cardiovasc Qual Outcomes Date: 2011-07
Authors: Christian Torp-Pedersen; Marco Metra; Andrew Charlesworth; Phillip Spark; Mary Ann Lukas; Philip A Poole-Wilson; Karl Swedberg; John G F Cleland; Andrea Di Lenarda; Willem J Remme; Armin Scherhag Journal: Heart Date: 2007-01-19 Impact factor: 5.994
Authors: Catherine S Barnes; David C Ziemer; Chris D Miller; Joyce P Doyle; Clyde Watkins; Curtiss B Cook; Dan L Gallina; Imad el-Kebbi; William T Branch; Lawrence S Phillips Journal: Diabetes Educ Date: 2004 Jan-Feb Impact factor: 2.140
Authors: Stephen D Wiviott; Eugene Braunwald; Dominick J Angiolillo; Simha Meisel; Anthony J Dalby; Freek W A Verheugt; Shaun G Goodman; Ramon Corbalan; Drew A Purdy; Sabina A Murphy; Carolyn H McCabe; Elliott M Antman Journal: Circulation Date: 2008-08-31 Impact factor: 29.690
Authors: Walter Zidek; Joachim Schrader; Stephan Lüders; Stephan Matthaei; Christoph Hasslacher; Joachim Hoyer; Claudia Zemmrich; Peter Bramlage; Claus-Dieter Sturm; W Dieter Paar Journal: Cardiovasc Diabetol Date: 2012-01-09 Impact factor: 9.951
Authors: Joshua M Stolker; John A Spertus; Darren K McGuire; Marcus Lind; Fengming Tang; Philip G Jones; Silvio E Inzucchi; Saif S Rathore; Thomas M Maddox; Frederick A Masoudi; Mikhail Kosiborod Journal: Diabetes Care Date: 2012-03-12 Impact factor: 19.112
Authors: Suzanne V Arnold; Kasia J Lipska; Silvio E Inzucchi; Yan Li; Philip G Jones; Darren K McGuire; Abhinav Goyal; Joshua M Stolker; Marcus Lind; John A Spertus; Mikhail Kosiborod Journal: BMJ Open Diabetes Res Care Date: 2014-11-04
Authors: Anna Grodzinsky; Mikhail Kosiborod; Fengming Tang; Philip G Jones; Darren K McGuire; John A Spertus; John F Beltrame; Jae-Sik Jang; Abhinav Goyal; Neel M Butala; Robert W Yeh; Suzanne V Arnold Journal: Circ Cardiovasc Qual Outcomes Date: 2017-09
Authors: Sebastian T Lugg; Christine J H May; Peter Nightingale; Robbie P E Tuffley; June Al-Hourani; Parijat De Journal: J Diabetes Metab Disord Date: 2017-04-04
Authors: Qinglan Ding; Marjorie Funk; Erica S Spatz; Robin Whittemore; Haiqun Lin; Kasia J Lipska; Rachel P Dreyer; John A Spertus; Harlan M Krumholz Journal: J Am Heart Assoc Date: 2019-08-23 Impact factor: 5.501
Authors: Gregory G Schwartz; Lawrence A Leiter; Christie M Ballantyne; Philip J Barter; Donald M Black; David Kallend; Fouzia Laghrissi-Thode; Eran Leitersdorf; John J V McMurray; Stephen J Nicholls; Anders G Olsson; David Preiss; Prediman K Shah; Jean-Claude Tardif; John Kittelson Journal: Diabetes Care Date: 2020-03-06 Impact factor: 19.112